Re: First Denial from Aetna

[Guest guest]

Turns out the denial was from the first request before we even did

any measurements. They just sent in the prescription and a letter of

medical neccesity. We had already gotten one letter saying they

closed the request and then we got the other letter more than a week

later.

Lori

> >

> > We recently recieved our first denial letter from Aetna it

reads as

> > thus:

> >

> > A charge for a service or supply is not covered to the extnt

that it

> > is determined by us to be experimental or investigational. A

Medical

> > Policy Administration medical director, board certified in

Internal

> > Medicine/Hematology has reviewed your request, including all

> > supporting documentation submitted to date. After this

review, we

> > have determined that the proposed remodeling band (or helmet)

as

> > durable medical equipment medically necessary for moderate to

severe

> > positional head deformities associated with premature birth,

> > restrictive intrauterine positioning, cervical abnormalities,

birth

> > trauma, torticollis, and sleeping positions in children when

banding

> > is initiated at 4 to 12 months of age and the following

conitions are

> > met: A 2-month trial of conservative therapy consisting of

> > repositioning the child's head such that the child lies

opplosite to

> > the preffered position, has failed to improve the deformity

and is

> > judged to be unlikely to do so, an A difference of Asymmetry

greater

> > thatn 6 mm between anthropometric measurements. Aetna

considers the

> > use of a cranial remolding band (or helmet) for persons not

meeting

> > the aforementioned criteria experimental and investigational.

> >

> > We have been repositioning him since 3 months and he has a

17mm

> > assemetry. I don't really understand why they would deny him

based

> > on this information. But now first appeal begins.

> >

> > I would greatly appreciate any and all comments or assistance

in

> > compiling all information to prepare this.

> >

> > thanks a bunch!

> >

> > Lori

> > mom to:

> > Hannah 2yrs

> > Garrett 9 months

> >

>

>

>

>

>

>

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